摘要
目的观察乙酰胆碱诱发冠状动脉痉挛试验前后心律失常及校正QT间期（QTc）的变化。方法选择冠状动脉造影显示冠状动脉主干及其分支狭窄〈50％的受试者149例，行乙酰胆碱诱发冠状动脉痉挛试验，根据试验结果分为冠状动脉痉挛组80例、冠状动脉微循环障碍组31例和对照组38例，试验过程中经冠状静脉窦采血检测乳酸水平，全程监测并分析各组心律失常及心电图QTc的变化。结果新出现的较严重心律失常发生率为28．2％（42／149），其中起搏心律发生率为18．1％（27／149），第二度或第三度房室阻滞发生率为6．0％（9／149），非持续性房性心动过速、心房颤动发生率为3．4％（5／149）。三组各种心律失常的发生率比较差异无统计学意义（P〉0．05）；室性心动过速、心室颤动需电复律1例，发生率为0．7％（1／149），与冠状动脉痉挛相关。三组基础QTc比较差异无统计学意义（P〉0．05），注射乙酰胆碱后，冠状动脉痉挛组、冠状动脉微循环障碍组QTc分别延长至（448．4±37．6）ms及（455．9±36．5）ms，与对照组的（432．6±34．1）ms比较差异有统计学意义（P〈0．05）.结论乙酰胆碱诱发冠状动脉痉挛试验过程中，可引起缓慢性或快速性心律失常，大多与乙酰胆碱的药理作用相关，乙酰胆碱尚可引起QTc延长，冠状动脉痉挛、冠状动脉微循环障碍者QTc延长更显著。
Objective To determine the changes of arrhythmia and correct QT （QTc） before and after the intracoronary injection of acetylcholine. Methods The intracoronary injection of acetylcholine was tested in 149 patients with main coronary artery and branch stenosis less than 50% by coronary arteriongraphy, 149 patients were divided into coronary spasm group （ 80 patients ）, microvaseular spasm group （ 31 patients ） and control group （38 patients） according to the results of the intracoronary injection of acetylcholine. The level of lactic acid in coronary sinus was detected, arrhythmia and QTc were monitored and analyzed. Results The emerging incidence of serious arrhythmia was 28.2% （42/149）. The incidence of cardiac rhythm by pacing was 18.1%（27/149 ） ,the incidence of second to third degree atrioventricular block was 6.0%（9/149 ）, the incidence of paroxysmal atrial tachycardia and paroxysmal atrial fibrillation was 3.4% （5/149）. There was no significant difference in the incidence of arrhythmia among three groups （P 〉 0.05 ）. The incidence of ventricular tachycardia and ventricular fibrillation which needed to be managed by electroverting was 0.7% （ 1/149 ）. And the ventrieular taehycardia and ventricular fibrillation was found in coronary spasm group. The baseline QTc tended to have no significant change among coronary spasm group, microvascular spasm group and control group （P 〉 0.05 ）. After administration of acetylcholine in coronary spasm group and microvascular spasm group, QTc increased to （448.4 ± 37.6） ms and （455.9 ± 36.5） ms,and there was significant difference compared with that in control group[ （432.6 ± 34.1 ） ms ] （P 〈 0.05）. Conclusions Bradyarrhythmia and tachyarrhythmia is associated with the pharmacologic action of acetylcholine. However, ventricular tachycardia and ventricular fibrillation is associated with coronary artery spasm. The intracoronary injection of acetylcholine can cause the QTc increase, especially in patients with coronary spasm or microvascular spasm.
出处
《中国医师进修杂志》
2012年第1期26-29,共4页
Chinese Journal of Postgraduates of Medicine
